Some Medi-Cal Patients Experience Difficulties in Managed Care Switch
California's initiative to shift Medi-Cal beneficiaries into managed care plans has forced some low-income seniors and disabled patients with disabilities to give up their switch physicians, delay treatment and travel long distances to seek for specialty care, the Los Angeles Times reports.Â
Medi-Cal is California's Medicaid program.
As of July, California has transferred about 333,000 beneficiaries into managed care plans.
State health officials said the managed care system oversees all of patients' treatments and helps prevent unnecessary procedures and hospital visits.
Details of Exemptions
Beneficiaries who want to stay on a fee-for-service plan can apply for a temporary exemption. However, patients mustÂ require ongoing care for a serious illness to qualify for the exemption.
Susan McClaire, senior medical consultant with the state Medi-Cal Managed Care Division, said, "The criteria is met by very few people."
According to the state, nearly 18% of the 19,684 beneficiaries who applied for the exemptions between June 2011 and April were approved. Nearly 32% of beneficiaries who applied for exemptions were denied, while the remaining beneficiaries were told they had incomplete paperwork.
Margaret Tatar, chief of the Medi-Cal Managed Care Division, said that beneficiaries can request to continue being treated by their current physician for one year.
The state granted 8,963 patient requests to continue to see their current physicianÂ and denied 1,582 of those requests between June 2011 and March, according to the Times.
Toni Vargas -- staff attorney at Neighborhood Legal Services -- said that once beneficiaries are transferred to managed care plans, many of them do not receive needed treatment.
She said, "They were pushed in a system that wasn't ready to take on this population."
Vargas added that the transfer process is "frightening and confusing" for beneficiaries, many of whom have mental health issues. She noted, "They don't know or can't figure out how to use the plans."
However, state health officials said that staying on fee-for-service plans does not work well for most patients or for the state.
Tatar said the state aggressively monitors health plans and investigates specific complaints.
She said that state officials seek to ensure that patient care is not disrupted (Gorman, Los Angeles Times, 7/2).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.